Daniel Sokol: Assisted dying is compatible with the Hippocratic Oath

February 14, 2019

Geoff Whaley, a terminally ill man with motor neurone disease recently travelled from the UK to a Dignitas facility in Switzerland to end his own life. Shortly before his death, Mr Whaley urged MPs to change the law to allow assisted dying in the UK. This comes as The Royal College of Physicians are polling its members to gauge their views on assisted dying—a poll which has been condemned for having a “rigged outcome.” The question of whether to permit assisted dying has returned with renewed vigour.

The British Medical Association is opposed to assisted dying because it violates ‘the ethics of clinical practice, as the principal purpose of medicine is to improve patient’s quality of life, not to foreshorten it.’

This view is echoed by Amy Proffitt, the Honorary Secretary of the Association for Palliative Medicine, who believes assisted dying “changes Hippocratic duties of doctors and goes to the heart of medicine.”

My disagreement with this view became clear to me a few years ago, when I spoke to the late Rick Jolly, a former military surgeon who was the only serviceman honoured by both the British and Argentinian sides in the Falklands war of 1982.

When he found out I was a medical ethicist, he told me a story about an incident that took place on 1st June 1982.

An Argentine prisoner of war was moving unexploded bombs from one place to another when one exploded and engulfed him in flames. A British medic tried to reach him but could not get close due to the intense heat. After five minutes, the burning prisoner was still moving. There was no longer any hope of survival. The medic grabbed his rifle and shot him four times to end his suffering.

Did the medic act in a way that was contrary to the ethics of medicine by shortening the soldier’s life?

The Hippocratic Oath contains this line “I will not give a drug that is deadly.” This is often interpreted as a prohibition of euthanasia. However, both the great lexicographer Emile Littré and the respected physician-ethicist Steven Miles conclude that this was in fact a prohibition against doctors collaborating in murder.

Political murder was common in Ancient Greece and doctors were sought after for their expertise in poison.

Instead, the Oath talks of going into the houses of patients “for the benefit of the ill”.

All doctors recognise that there are conditions worse than death, even with good palliative care. In those situations, death is a benefit to the sufferer rather than a harm. Many of us would consider the burning soldier’s plight to be worse than death, for example, and we understand the tragic decision of those stranded in the World Trade Center on 9/11 to leap from the windows rather than endure the alternative.

Every day, doctors make decisions knowing that they will shorten their patients’ lives. A doctor withdraws life support from a terminally ill patient in the knowledge that the patient will die sooner than he otherwise would; a surgeon decides against an operation to remove a brain stem tumour because, although the patient might live a little longer, life after surgery would be terrible. Yet, no one asserts that these actions are contrary to the ethics of medicine.

What is missing from the reasoning of the opponents of assisted dying is the realisation that a key purpose of medicine is the relief of human suffering. As technological advances allow us to delay death even in the most dire of circumstances, the issue of assisted dying becomes more pressing. Prolonging life can extend suffering.

The doctor who administers a fatal injection to a patient with end stage motor neurone disease, who has asked clearly and repeatedly for an earlier death, is relieving human suffering. He or she should be no more criticised than the doctor who switches off the ventilator from a patient with full capacity who decides that “enough is enough.” Both are acting in accordance with the Hippocratic commitment to benefit the sick and alleviate suffering.

The wrongness of assisted dying, if it is wrong, must be found elsewhere.

Daniel Sokol is a medical ethicist and author of “Tough Choices: Stories from the Front Line of Medical Ethics” (Book Guild, 2018).

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